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Which of the following findings is most likely over the course of this disease? A 60-year-old man comes to the physician because of progressive weakness of his hands during the past 6 months. He works as a carpenter and has had difficulty handling his tools. He has smoked 1 pack of cigarettes daily for 45 years. He drinks two beers daily during the workweek and approximately six beers daily on weekends. Physical examination shows no lymphadenopathy. There is decreased strength (4/5) in the upper and lower extremities and atrophy of the muscles of the hands. He has diffuse hyperreflexia. Fasciculations are noticed on the muscles of the hands and upper extremities. Sensory examination is normal.



A. Dementia
B. Difficulty swallowing
C. Loss of facial sensation
D. Loss of peripheral vibratory sensation
E. Nystagmus

This question is part of NBME 13 Section 4 (qst 1-50)
Asked by Chachelly, Last updated: Jul 04, 2020

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2 Answers

E. Stanley

E. Stanley, Technical writer, Indianapolis

Answered Feb 13, 2019

The correct answer to this question is B. The patient is showing symptoms typical of amyotrophic lateral sclerosis (ALS), a rare and progressive neurodegenerative disease that affects nerve cells in the brain, brain stem, and the spinal cord.

ALS causes the destruction of motor neurons that result in early signs and symptoms such as difficulty walking, weakness in lower extremities, hand weakness or clumsiness, slurred speech or difficulty swallowing, and muscle cramps and twitching, many of which are present in this patient.

The life expectancy of a person diagnosed with ALS averages approximately two to five years, although many people do live longer.

 

John Smith

John Smith

Answered Aug 08, 2017

Difficulty swallowing
 

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